Organization
MED SPORTS VANTAGE PLLC
Active
Other names
Med Sports Vantage PLLC, Med Sports Vantage
Organization subpart
No
Provider details
NPI number
Authorized official
RACHEL LETHORN PA-C (CEO / OWNER)
(810) 626-3036
Entity
Organization
Contact information
Practice address
210 S EAST ST STE 2, BRIGHTON, MI 48116-1592
(810) 626-3036
(810) 202-1130
Mailing address
210 S EAST ST STE 2, BRIGHTON, MI 48116-1592
(810) 626-3036
(810) 202-1130
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
5601003608
MI
261QM2500X
Medical Specialty Clinic/Center
5601003608
MI
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
5601003608
MI
Other
Enumeration date
02/14/2017
Last updated
03/25/2023
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